types, investigation, complication and treatment of incisional hernia
TRANSCRIPT
![Page 1: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/1.jpg)
Dr. Muhammad Ayoub JalbaniAssistant ProfessorSurgical UNIT III
![Page 2: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/2.jpg)
Anatomy of the Abdominal Wall
![Page 3: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/3.jpg)
Anatomy of the Abdominal Wall
![Page 4: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/4.jpg)
Function of Musculofascial Layers5 paired muscles (3 flat, 2 vertical)3 flat – int/ext oblique and transversalisIncrease abdominal pressure to facilitate
defecation, micturition, and parturitionStabilizes trunk 2 vertical – rectus abdominus and
pyramidalisRectus - tensor of the abdominal wall,
flexor of the vertebrae, stabilize the pelvis during walking, protects the abdominal viscera, aids in forced expiration
![Page 5: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/5.jpg)
Anatomy
![Page 6: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/6.jpg)
INCISIONAL HERNIA
It is herniation through a weak abdominal scar (scar of previous surgery).
It is common in old age and obese individuals.
![Page 7: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/7.jpg)
Predisposing FactorsVertical scar, midline scar, lower
abdominal scar— may injure the nerves of the abdominal muscles.
Scar of major surgeries (biliary, pancreatic).
Scar of emergency surgeries (peritonitis, acute abdomen).
![Page 8: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/8.jpg)
Cont..Faulty technique of closure.Poor nutritional status of the patient.
Presence of cough, tuberculosis, jaundice, anaemia, hypoproteinaemia.
![Page 9: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/9.jpg)
Cont..Malignancy, immunosuppression.Smoking in postoperative period.Causes which increases the intra-
abdominal pressure (BPH, straining, stricture urethra or rectum, ascites).
![Page 10: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/10.jpg)
Factors responsible for development of Incisional hernia
Vertical incision has got higher chances of incisional hernia than horizontal incision
Layered closure of the abdomen has got higher chance than single layer
Continuous closure has got higher chances than interrupted closure
![Page 11: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/11.jpg)
Cont..Using absorbable suture material has got
higher chances of hernia than non-absorbable sutures
Emergency surgical wound has higher chances than elective surgical wound
Laparotomy for peritonitis, acute abdomen, and trauma can commonly cause incisional hernia
![Page 12: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/12.jpg)
Drainage through the main laparotomy wound may precipitate formation of incisional hernia
Chronic cough, smoking, obstructive uropathy, constipation can precipitate incisional hernia
![Page 13: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/13.jpg)
Diabetes, old age, malnutrition, malignancy, anaemia, hypoproteinaemia, jaundice, ascites, liver disease, uraemia, steroid therapy, immunosuppressive diseases are other precipitating factors
![Page 14: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/14.jpg)
Clinical Features
Swelling in the scar region.Pain.Impulse on coughing.Gurgling sound.Often bowel peristalsis may be visible under the skin.
![Page 15: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/15.jpg)
Eventually features of irreducibility, obstruction,
strangulation is seen.Hernia is common in lower abdomen.
It may be small or large; huge or massive (diffuse)
![Page 16: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/16.jpg)
Scar, its extent and location, whether healed primarily or secondarily, skin over the scar and swelling is noted. Details of the swelling with expansile impulse on coughing and examination both in lying down and standing are done.
Gap cannot be assessed in an irreducible hernia.
![Page 17: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/17.jpg)
![Page 18: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/18.jpg)
![Page 19: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/19.jpg)
![Page 20: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/20.jpg)
Type of defects in Incisional Hernia
Small defectLarge and wide defectVery large defectMassive / diffuseMultiple defects
![Page 21: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/21.jpg)
Investigations:
Always the precipitating factors must be looked for:
Chest X-ray.U/S abdomen.Tests relevant for causes.
![Page 22: Types, Investigation, complication and treatment of Incisional hernia](https://reader035.vdocuments.mx/reader035/viewer/2022062523/58f9b2f0760da3da068bd0f5/html5/thumbnails/22.jpg)
Complications of incisional hernia
Irreducibility,Obstruction, Strangulation, Incarceration.